Provider Demographics
NPI:1376959395
Name:TRAN, THIEN T (OD)
Entity Type:Individual
Prefix:
First Name:THIEN
Middle Name:T
Last Name:TRAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1092 N STATE COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-2701
Mailing Address - Country:US
Mailing Address - Phone:714-635-8671
Mailing Address - Fax:714-635-9401
Practice Address - Street 1:1092 N STATE COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-2701
Practice Address - Country:US
Practice Address - Phone:714-635-8671
Practice Address - Fax:714-635-9401
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15094TLG152WL0500X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1124091-04Medicaid
TX00E63GMedicare UPIN